Highlighting the need for de-implementation - Choosing Wisely recommendations based on clinical practice guidelines.

Area of Science:

• Health Services Research
• Clinical Practice Guidelines
• Evidence-Based Medicine

Background:

• The Choosing Wisely campaign promotes evidence-based healthcare, but recommendation development methods vary globally.
• This study details a systematic process for creating Choosing Wisely recommendations from national clinical practice guidelines.

Purpose of the Study:

• To describe a structured methodology for developing Choosing Wisely recommendations.
• To report the outcomes of a one-year Choosing Wisely Finland project.

Main Methods:

• Developed quality criteria (relevance, feasibility, evidence-based, strength) and piloted recommendation development processes (A, B, C).
• Process A: Editor drafts recommendations based on published guidelines, revised by guideline group.
• Process B: Integrated recommendation development with guideline production/updates. Process C: Independent recommendation development.

Main Results:

• Recommendations were identified in 39/52 guidelines; 62/106 drafted recommendations were accepted (58%).
• Key rejection reasons: inability to give a strong recommendation (41%) and insufficient relevance (32%).
• 66% of published recommendations used high/moderate evidence; 18% used low/very low evidence.

Conclusions:

• Choosing Wisely recommendations can be systematically generated from existing clinical practice guidelines.
• The adopted evidence-based medicine methods ensure high-quality recommendations.
• The described processes and methods are adaptable for other guideline-producing organizations.